Provider Demographics
NPI:1194051201
Name:LANTING, KIMBERLY RHEA (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RHEA
Last Name:LANTING
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26951 SUMMIT PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97869-8208
Mailing Address - Country:US
Mailing Address - Phone:541-820-4615
Mailing Address - Fax:
Practice Address - Street 1:3325 POCAHONTAS RD
Practice Address - Street 2:ST. ELIZABETH HEALTH SERVICES
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814
Practice Address - Country:US
Practice Address - Phone:541-523-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID924524133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered